Optical Monitoring of Cerebral Hemodynamics during Mechanical Thrombectomy

机械血栓切除术中脑血流动力学的光学监测

• 批准号: 10019609
• 负责人: Christopher G. Favilla
• 金额: $ 19.6万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-30 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10019609
• 关键词: Acute; Angiography; Arteries; Bilateral; Biometry; Blood Pressure; Blood Vessels; Blood flow; Caring; Cerebrovascular Circulation; Cerebrovascular Physiology; Cerebrum; Clinical; Coagulation Process; Cohort Studies; Comb animal structure; Data; Detection; Development; Diffuse; Ensure; Forehead; Foundations; Functional disorder; Future; Goals; Growth; Hair; Homeostasis; Hour; Image; Impairment; Incidence; Infarction; International; Intervention; Intervention Studies; Ischemic Stroke; K-Series Research Career Programs; Location; Magnetic Resonance Imaging; Measurement; Measures; Mechanics; Mentors; Mentorship; Methodological Studies; Methodology; Methods; Microcirculation; Monitor; Neurologist; Optical Methods; Optics; Outcome; Parietal; Parietal Lobe; Patients; Perfusion; Physicians; Physiology; Prevalence; Procedures; Reperfusion Therapy; Research; Research Personnel; Research Training; Resolution; Role; Scientist; Signal Transduction; Spatial Distribution; Spectrum Analysis; Stroke; Structure; Technology; Testing; Thrombectomy; Time; Tissues; Training; Treatment outcome; Validation; Variant; Work; acute stroke; base; blood flow measurement; career development; cerebral hemodynamics; cerebral microvasculature; cerebrovascular; clinical application; clinical care; clinical practice; clinically significant; experience; frontal lobe; hemodynamics; high risk; hypoperfusion; improved; improved outcome; individual variation; neuroimaging; neuroprotection; new technology; new therapeutic target; novel; patient variability; programs; response; restoration; senior faculty; signal processing; skills; spatiotemporal; standard of care; statistics; stroke patient; stroke therapy; success; supportive environment; tool

PROJECT SUMMARY Restoration and optimization of cerebral blood flow (CBF) are the cornerstones of acute stroke management, but evidence suggests substantial hemodynamic variability between patients. Over the last few years, mechanical thrombectomy has revolutionized treatment for acute stroke with large vessel occlusion. With this procedure, clot is endovascularly removed to achieve large artery recanalization in the majority of patients. Unfortunately, microvascular hypoperfusion can persist despite large vessel recanalization, and microvascular flow status is a better predictor of infarct volume and clinical outcome than large artery recanalization. This proposal seeks to apply novel methods, most notable diffuse correlation spectroscopy, for noninvasive assessment of cerebral microvascular hemodynamics during mechanical thrombectomy. This work will identify individual variability in microvascular reperfusion. Impaired autoregulation is known to occur in acute stroke, and provides the rationale for liberalization of blood pressure targets. DCS data will also be used for bedside measurement of individual variations in cerebral autoregulation based on dynamic correlations between arterial blood pressure and CBF. Finally, structural and perfusion MRI will be used to assess imaging outcomes, and for validation of optical CBF measurements. This project will define the incidence and clinical significance of persistent microvascular hypoperfusion and autoregulatory dysfunction after thrombectomy, which in future work will serve as novel therapeutic targets to individualize stroke treatment and further improve clinical outcomes. The proposed work will also provide critical career development for the candidate’s growth towards independence, with expertise in measuring cerebral hemodynamics and penumbral physiology in acute stroke. This proposal builds upon the candidate’s foundation in optical blood flow monitoring, expanding its application to a high-acuity setting, leveraging the technology’s advantage as a non-invasive bedside tool. Training in advanced MRI as a complementary tool for assessing cerebral hemodynamics with high spatial resolution will diversify the candidate’s expertise. The proposal will also provide training in advanced biostatistics, study methodology, and rigor. Mentorship, critical to the candidate’s success, will be provided by an experienced interdisciplinary team of senior faculty with a track record of success in training independent researchers. The team is led by: (1) primary mentor Dr. John Detre, a world renowned expert in neuroimaging, who has been critical in the development of optical and MRI methods utilized in this proposal, (2) Dr. Scott Kasner, an internationally distinguished stroke clinical trialist, and (3) Dr. Arjun Yodh, an internationally renowned investigator in biomedical optics and developer of the technology used in this work. These mentors will ensure the proposed research and training plan guide the candidate in establishing an independent research program in non-invasive cerebral hemodynamic monitoring.

项目摘要 脑血流（CBF）的恢复和优化是急性卒中管理的基石， 但有证据表明，患者之间的血液动力学差异很大。在过去的几年里， 机械血栓切除术已经彻底改变了对大血管闭塞的急性中风的治疗。与此 在大多数患者中，在血管内清除凝块以实现大动脉再通。 不幸的是，尽管大血管再通，微血管灌注不足仍可能持续， 血流状态比大动脉再通更能预测梗死体积和临床结局。 该提案旨在应用新的方法，最显着的扩散相关光谱， 机械血栓切除术期间脑微血管血流动力学的评估。这项工作将确定 微血管再灌注的个体差异。已知自动调节受损发生在急性中风中， 为血压目标的自由化提供了理论基础。DCS数据也将用于床旁 基于动脉和脑动脉之间动态相关性的脑自动调节个体差异的测量 血压和CBF。最后，结构和灌注MRI将用于评估成像结果， 用于光学CBF测量的验证。本项目将定义以下疾病的发生率和临床意义： 血栓切除术后持续的微血管灌注不足和自身调节功能障碍， 将作为新的治疗靶点，使卒中治疗个体化，并进一步改善临床结局。 拟议的工作还将为候选人的成长提供关键的职业发展， 独立性，具有测量急性卒中脑血流动力学和半影生理学的专业知识。 该提案建立在候选人在光学血流监测方面的基础上，扩大了其应用范围 到高敏锐度设置，利用该技术作为非侵入性床边工具的优势。培训 先进的磁共振成像作为一种补充工具，用于评估具有高空间分辨率的脑血流动力学， 使候选人的专业知识多样化。该提案还将提供高级生物统计学培训， 方法论和严谨性 导师，对候选人的成功至关重要，将由资深的跨学科团队提供 在培养独立研究人员方面有成功记录的教师。团队由以下人员领导：（1）主要导师 博士John Detre是世界著名的神经成像专家，他在光学成像的发展中发挥了关键作用。 （2）Scott Kasner博士，一位国际著名的中风临床专家， Trialist和（3）Arjun Yodh博士，国际知名的生物医学光学研究员和 这项工作中使用的技术。这些导师将确保拟议的研究和培训计划指导 候选人在建立一个独立的研究计划，在无创脑血流动力学监测。